Bad Times for Pregnant Women

Maybe it’s just me, but I feel like every day this week I’ve seen another story about questionable to outright appalling treatment of pregnant women. One was the case of a woman with allegedly false immigration documents, who learned that she was pregnant and HIV positive. The judge in that case decided to sentence her to prison through her due date (longer than the sentence might otherwise have been), under the rationale that she would receive medical/HIV treatment in prison. Something is really, really wrong when prison is a first, best option for medical care, especially for a pregnant woman. Apparently this decision wasn’t made on behalf of the woman and whatever pregnancy-related care she may need, though, but with an eye toward forcing her to take medications to reduce transmission to the fetus. RH Reality Check has more background and detailed analysis here, and an update from after bail was granted, following an outcry from groups such as the National Advocates for Pregnant Women and the ACLU.

There’s also a class action lawsuit brewing against the Cook County (IL) Sheriff’s Department from women who were cuffed while giving birth (who were incarcerated at the time). According to the linked piece, “The women’s lawyers say as many as 100 women held in Cook County facilities have been handcuffed or shackled while giving birth.” You all know I don’t approve of that. At all.

Court records obtained by The Clarion-Ledger indicate Cruz is charged with neglecting her child, in part, because “she has failed to learn the English language” and “was unable to call for assistance for transportation to the hospital” to give birth. Her inability to speak English “placed her unborn child in danger and will place the baby in danger in the future,” according to the document.

They add that the hospital document accused the mother of “exchanging living arrangements for sex” and planning to place the child up for adoption, although an advocacy organization involved in the case disputes the allegations. While little other information is available about this case, it’s terrifying to think that someone could potentially have their child taken away simply because of a language barrier and/or a hospital staff that ineptly selects an interpreter.

In all of these cases, the women involved were particularly vulnerable – through their immigration status, through their language, through their status as incarcerated women – vulnerabilities that were piled onto because of their status as pregnant women. I don’t have anything truly profound to say about these cases, but that I’m glad organizations like NAPW and others are out there and paying attention to the civil liberties of pregnant women.

I am pro-choice without reservation. However, if a woman chooses to have a baby she has a responsibility to do everything in her power to make sure it is a healthy baby. If you are HIV positive and decide to have a baby you can’t also decide not to take medication. If you are an alcoholic and choose to have a baby you must stop drinking. It’s still your body but if you decide to share it with a baby you are no longer the sole proprietor. It is a preview of what happens once you have a child. If you drink excessively and forget to eat, that is your problem. If you drink excessively and neglect to feed your child, the child will be taken away from you.

Stephanie, thanks for commenting. I think it’s tricky, ethically, because you’re talking about what an individual can be compelled to do for the benefit of another individual (I’m sure my libertarian friends will jump on that with examples of where I’m inconsistent with the principle in other realms). MomsTinfoilHat has a couple of interesting related discussions on HIV testing of neonates and pregnant women, and I have some comments and links to further discussion in an old post at Our Bodies Our Blog, if you or other readers are interested in taking a look

It is not just you who thinks recent news on the treatment of pregnant women is appalling. I posted on the Cook county story and the jailed HIV pregnant woman. I do however have very strong feelings about perinatal HIV testing. I do not find it ethically challenging even. You know that an HIV positive pregnant mom has a 25% chance of transmitting the virus to her baby if she does not get treatment. With treatment, the transmission rate can decrease to 2%. No one can force this mom into treatment (which would of course benefit the mom also). If this mom refuses treatment the baby has a 25% chance of getting HIV. If we treat this infant early after birth, that rate can decrease by 50%. Why should we allow a mom to refuse life saving treatment and testing for a new, autonomous human being, who is now not connected to her body?
I coincidentally, know and have worked with the physician champion of perinatal HIV testing in my state, and with her peers. They are all women, who only have the health and well being of moms and infants in their hearts. Yet, they are occasionally demonized for taking away women’s rights. It is sad and disheartening and makes me wonder why I have devoted my career to helping women and children.